H.R. 3162 (Dingell)

Reauthorization of SCHIP and State Allotments
Reauthorizes SCHIP permanently, changes formula for state allotments to reflect actual or projected spending, and increases funding to territories. A shortfall adjustment is provided if a state's expenditures exceed its allotment and program enrollment has increased faster than the state's percentage increase in child population growth plus one. Funds are available to states for two years. The bill would change how unused allotments are distributed to states with funding shortfalls.

States are eligible for a performance bonus payment to offset additional costs resulting from adoption of specific enrollment and retention efforts. (See "Outreach and Enrollment). For Medicaid enrollment increases less than or equal to 3% above the baseline (population growth plus 1 percentage point), the bonus payment per additional enrollee would equal 35% of per capita Medicaid expenditures for children; for SCHIP enrollment increases of less than 7.5% above the baseline, the bonus payment per additional enrollee would be 5% of per capita SCHIP expenditures. Bonus payments for increases beyond these levels are 90% of per capita expenditures for Medicaid and 75% for SCHIP.

Coverage Expansions
Provides for new state coverage options: coverage of pregnant women up to the state's income eligibility level for children with automatic enrollment of newborns, coverage of legal immigrant pregnant women and children under Medicaid and SCHIP, and coverage of older children up to age 21.

Establishes a five year demonstration project under which up to 10 states would be permitted to use SCHIP funds to purchase employer-based coverage for children for qualifying plans. Employers would have to pay for at least 50% of the cost of family coverage in excess of the family's contribution and certain other requirements on the state and employers would have to be met.

Prohibits the coverage of non-pregnant childless adults through SCHIP waivers unless the Secretary determines that doing so would not deny coverage to eligible children. No waiting lists for children would be permitted in these states and outreach programs would be required.

Other changes to SCHIP or Medicaid coverage for children
Requires state SCHIP coverage of dental services effective October 1, 2008. Also requires coverage of federally qualified health center and rural health clinic services and requires they be paid as they are under Medicaid.

Mental health benefits must be provided at 100% of their actuarial value in the benchmark plan (75% under current law). Limits option for Secretary-approved plans to those with benefits at least equivalent to a benchmark plan. Most popular plan for dependent coverage becomes the state employee plan benchmark.

Requires states to provide enrollees with notice and a grace period for payment of premiums of at least 30 days prior to termination of coverage.

Requires the Secretary to develop and implement dental education for parents of newborns and prohibits states from preventing health centers from contracting with private dental providers under Medicaid or SCHIP. States must report on the number of SCHIP- enrolled children receiving dental services.

Imposes a moratorium on administrative action to restrict Medicaid coverage or payment for rehabilitation services or school based administration, transportation or medical services if restrictions are greater than those in effect on July 1, 2007. Adds school based health center services to coverage of clinic services.

Outreach and enrollment
States receive a performance bonus payment (see "Reauthorization of SCHIP and State Allotments") if they implement at least 4 of the following: 1) 12 months continuous eligibility for all children under Medicaid and SCHIP, 2) liberalization of asset requirement, 3) elimination of in-person interview requirement, 4) joint application for Medicaid and SCHIP, 5) automatic renewal, 6) presumptive eligibility for children under both Medicaid and SCHIP, and 7) "express lane" eligibility (a new state option described below).

Provides states the option of using an "express lane" process for determining a child's eligibility under Medicaid or SCHIP. Under this process, income determinations made through application for federal programs including temporary assistance to needy families (TANF), Food Stamps, child nutrition and school lunch programs along with those made by other state designated agencies can be used to determine eligibility for Medicaid or SCHIP. Under this option, states must provide for a regular eligibility determination if a child is found to be ineligible using the "express lane" process, and must give notice and offer a regular eligibility determination to children found eligible for SCHIP if a lower premium payment might result. In addition, states must meet satisfy certain "screen and enroll" requirements.

Those states with SCHIP programs that are separate from and not in combination with Medicaid must provide 12 months continuous eligibility for all children with incomes under 200% of the federal poverty level (FPL).

Provides for 75% federal match of expenses on translation or interpretation services related to enrollment and retention of children.

Provides a state option to modify documentary evidence requirements for proof of citizenship (retroactively effective to enactment of the Deficit Reduction Act of 2005), prohibits federal payment for illegal aliens and requires state audits to demonstrate compliance with this requirement.

Extends existing requirements for Medicaid outreach to all pregnant women and children.

Directs the Comptroller General to consult with state Medicaid and SCHIP directors and develop a model process for coordination of enrollment and coverage across states for children who are outside their state of residency because they are migrant families, experience emergency evacuation, for educational needs, or for other reasons.

Other provisions
Creates a Children's Access Payment and Equality Commission to review federal and state payment policies and access to and affordability of services under Medicaid and SCHIP.

Requires the Secretary of HHS to develop pediatric quality measures that may be used by public and private payers by the end of fiscal year 2009 and provide for public reporting by January 1, 2009.

Requires the Secretary of HHS to provide an updated evaluation of SCHIP and report to Congress by the end of 2010.

Extends transitional Medicaid assistance through 2011 and provides states the option of family planning services only to women who are not pregnant but meet the state's income eligibility requirements for pregnant women.

Certain existing requirements for Medicaid managed care plans would be extended to SCHIP, including those relating to provision of information to enrollees, beneficiary protections, and quality assurance.

The term "CHIP" is deemed a reference to SCHIP, and a number of other changes to Medicaid and SCHIP are included.

Financing
The Congressional Budget Office estimates the bill to have a 10-year cost of $129 billion financed by $53 billion from increased tobacco taxes and the balance in savings from changes to Medicare, primarily a reduction in payments to Medicare Advantage plans.

Effective Date
Program reauthorization, provision regarding legal immigrants, and some other provisions effective on enactment; state options for coverage and outreach for all pregnant women and children, dental education and managed care effective January 1, 2008. Mental health benefits and benchmark changes effective 10/1/09 and the premium grace period effective 1/1/09.